gary scheiner, ms, cde improving diabetes control with accurate carb counting
TRANSCRIPT
Gary Scheiner, MS, CDEGary Scheiner, MS, CDE
Improving Diabetes Control with Accurate
Carb Counting
Carbohydrate CountingAdvantages
– Fewer high BGs– Fewer low BGs– No “off limits” foods– Flexibility in meal & snack
quantities
“The Frozen Tundra”
Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs
Carbohydrate…. rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols.. moderate digestion, partial absorption as glucose (50%) Protein…………… slow digestion, partial conversion to glucose* (~40%) Fat…………………. slow digestion, little conversion to glucose** (<20%)
Timed Effect on Blood Sugar Levels
* In absence of dietary carbs ** may cause insulin resistance in large qty
MEET THE CARBS!
Glucose Fructose (fruit sugar) Galactose Dextrose Lactose (milk sugar) Sucrose (table sugar)
“flavored” simple sugars:
• Maltose• High-Fructose Corn Syrup• Molasses• Brown Sugar• Honey
MEET THE CARBS!
Fruit Fruit Juice Candy Regular Soda Punch Wine
Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar
Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly
MEET THE CARBS!
“branched chain” G – G – G – G – G - G G – G / \ /G – G G G – G – G G – G – G \ / \ / G – G – G – G – G – G G – G – G – G – G – G \ \ G – G – G G – G – G – G – G
“straight chain”G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G
MEET THE CARBS!
• Potatoes• Rice• Noodles/Pasta• Cereal• Oatmeal• Bread
• Tortillas• Pancakes• Waffles• Crackers• Bagels• Pizza
• Beans• Corn• Pretzels• Chips• Popcorn• Beer
Now meet the lesser known carbs
(discount 100%!)
(discount 50%!)
Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol
(Rare… can ignore!)
The “fate” of dietary carbohydrates
Simple Carbohydrates (sugars)
Complex Carbohydrates (starches)
BloodGlucose
Does the Type of Carbohydrate Matter?
Glycemic IndexGlycemic Index
• All carbs (except fiber) convert to All carbs (except fiber) convert to blood glucose eventuallyblood glucose eventually
• G.I. Reflects the magnitude of blood G.I. Reflects the magnitude of blood glucose rise for the first 2 hours glucose rise for the first 2 hours following ingestionfollowing ingestion
• G.I. Number is % or rise relative to G.I. Number is % or rise relative to pure glucose (100% of glucose is in pure glucose (100% of glucose is in bloodstream within 2 hours)bloodstream within 2 hours)
Does the Type of Carbohydrate Matter?
Glycemic Index (contd.)Glycemic Index (contd.)Example:Example:
SpaghettiSpaghettiGI = 37GI = 37• Only 37% of spaghetti’s
carbs turn into blood glucose in the first 2 hours.
• The rest will convert to blood glucose over the next several hours.
Does the Type of Carbohydrate Matter?
Slow Stuff Average Stuff
Fast Stuff
PastaLegumes
Salad VeggiesDairy
Chocolate
FruitJuicePizzaSoupCake
Breads/CrackersSalty Snacks
PotatoesRice
CerealsSugary Candies
Ultimately, The Amount of Carbohydrate is More Important Than the Type
CARB BASICS QUIZ – True or False
• Equal amounts of sugar and starch will raise blood glucose the same amount.
• Fiber will raise blood glucose levels a little bit.
• “Sugar-Free” chocolate (made with sugar alcohol) will not raise blood glucose levels.
Methods for Counting Carbs Accurately
• The “Exchange” system• Food package labels• Resource listings• Portion estimation• Carb factors
The “Exchange” System
• Foods with common nutrient values are grouped together.
1 Fat
1 Meat
1 Vegetable
1 Milk
1 Fruit
1 Starch
0 5 10 15
Practice Counting Carbs Using the Exchange system
Breakfast Exchange/# Grams
1 large bagel (4 oz) starch (4) x 15 60g
1 tsp. margarine fat (1)x0 0g
1/2 cup orange juice fruit (1) 15g
6 oz skim milk milk (3/4) x 12 9g
Total Carbs: 84g
Nutrition Facts Label Method
• Labels are the best resource for carbohydrate counting
• Pay attention to:– Serving Size– Total Carbohydrate– Fiber & Sugar Alcohol (if
any)
Fiber and Carbohydrate Counting
• Included in total carbohydrate• Does not convert to glucose• Subtract fiber from the Total
Carbohydrate
Fiber and Carbohydrate Counting
• For example:13 g Total Carb- 3 g dietary fiber
Count as 10 grams carbohydrate
Sugar Alcohols and Carbohydrate Counting
• Artificial Sweeteners• Found in chewing gum, mints,
yogurt, ice cream, cookies and candy
• Digest slowly and partially ( 50%)
• Can cause diarrhea
Carbohydrate Counting Using Books
• Use for foods without a
Nutrition Facts Label– Fresh fruits – Fresh vegetables– Ethnic foods– Fresh baked goods– Restaurant foods
Carbohydrate Counting Using Websites
• USDA Food Composition– www.nal.usda.gov/fnic/foodcomp/sear
ch/
• Calorie King– www.calorieking.com
• Fast food companies’ or food manufacturers’ websites
Arby’s: www.arbys.com/nutrition/
Boston Market: www.bostonmarket.com/restaurant
Burger King:www.bk.com/Food/Nutrition/NutritionWizard/index.aspx
Dairy Queen: www.dairyqueen.com/en-US/Menus+and+Nutrition/Nutrition+Charts/default.htm
Denny’s: www.dennys.com/en/cms/Nutrition/Allergens/23.html
Dunkin’ Donuts: www.dunkindonuts.com/aboutus/nutrition/
KFC: www.kfc.com/kitchen/nutrition.htm
McDonald’s: www.mcdonalds.com/usa/eat/nutrition_info.html
Old Country/Hometown Buffet: www.buffet.com/nutritioncontent.htm
Pizza Hut: www.pizzahut.com/menu/nutritioninfo.asp
Starbuck’s: www.starbucks.com/retail/nutrition_info.asp
Subway: www.subway.com/applications/NutritionInfo/index.aspx
Taco Bell: www.tacobell.com/
Wendy’s: www.wendys.com/food/NutritionLanding.jsp
Insulin Pump Carb Databases
• Accu-Chek Spirit Palm Software
• Animas IR 1200, 1250, 2020
• Deltec Cozmo 1800
• OmniPod PDM
Portion Estimation Method• Use common, everyday objects to
measure the portion size of food– Soda can (12 fl.oz.) = 1 ½ cups– Baseball or adult’s fist = 1 cup– Child’s fist = ½ cup– Adult’s spread hand = 8” diameter– Adult’s palm = 4” diameter
Portion Estimation Method• Examples of 1-cup Carb Estimates:
Potato: 40g
Pasta: 40g
Rice: 50g
Rolls: 25g
Cereal: 25g
Fruit: 20g
Cooked Veggies: 10g
Salad Veggies: 5g
Corn: 30g
Peas: 30g
Beans: 40g
Pretzels: 25g
Chips: 15g
Popcorn: 5g
Ice Cream: 35g
Cake: 45g
Portion Estimation Method
•Estimate the carbs:
20g/cup
X 1 ¼ cups
25g
Portion Estimation Method
•Estimate the carbs:
5g / cup
X 3 cups
15g
Portion Estimation Method
•Estimate the carbs:25g / cup
X 1 ½ cups 38g
12g / cup
X 1 cup
= 12g
Total = 50g
Portion Estimation Method• Other “tricks”:
Long Sandwiches 8g per inch
Pizza 30g per adult hand-sized piece (fingers together)
Cookies 20g per adult-sized palm
Breaded meat/veg/cheese 4g small (“thumb/nugget sized”)10g large (“patty/palm-sized”)
Portion Estimation Method
•Estimate the carbs:
30g / hand
X 1 1/3 hands
40g
Carbohydrate Factor Method
• Weigh a portion of food• Multiply the weight by its carb
factor*• Get total carb count
*A carb factor is the percentage of the food’s weight that is carbohydrate. The rest is water, protein, fat, minerals
Carbohydrate Factor Method
Salter 1450
Carbohydrate Factor Method
Carb Factor Examples:
Apple: .13
Apple Pie: .32
Bagel: .51
Carrot (raw): .06
Chocolate Cake: .51
Cornbread: .45
Pancake: .28
For carb factors for more than 6000 foods (in Excel spreadsheet format), go to: www.friendswithdiabetes.org/files/Carb factor.xls
Pizza (cheese): .32
Potato, baked: .22
Potato Salad: .09
Rice: .27
Spaghetti: .26
Vanilla Ice Cream: .23
Watermelon: .06
Carbohydrate Factor Method
How much carb
is in a baked potato
weighing exactly 300
grams?
A. 36g
B. 46g
C. 66g
D. 86g
300 x .22g = 66g carb
Measuring and Weighing Foods
• To be an accurate carb counter, weigh/measure at least once a week
• Practice, practice, practice!
• Test yourself against the label
Other Factors to Consider
•Fat– Lengthens time your stomach takes to
empty– Delays rise in blood glucose– May cause temporary insulin resistance
•Protein– Very little effect on blood glucose
(unless carb diet)
– Usually combined with fat
Weight Gain and Carbohydrate Counting
Your can gain weight if:
• Count carbohydrate, but ignore fat/calorie content of foods
• No limits placed on portion sizes
• Frequent snacking
Write it down!
• Blood glucose results • Carbohydrate eaten• Insulin or other meds• Physical
activity/exercise
Only count the carbs you actually consume!
Jackie Scheiner
Age 1
The Ultimate Guide to Accurate Carb Counting
Gary Scheiner MS, CDE
Integrated Diabetes ServicesIn-Office, Phone & Online
Consults333 E. Lancaster Ave., Suite 204Wynnewood, PA 19096USA (877) [email protected]